HMR barriers hamper deprescribing

Deprescribing push being held back by low HMR uptake, experts say

While a range of studies and expert opinions have emphasised the vital role of deprescribing in elderly patients, it is being hampered by low HMR update, academics believe.

A recent analysis by NSW researchers, including pharmacy academics, described deprescribing as “an important challenge and not an easy one”.

They identified the importance of offering advice and the chance for further medical consultation regarding deprescribing at times of care transition, such as hospital admission or referral to aged care services.

In a letter in response to the article, Rohan Elliot from the Pharmacy Department, Austin Health, Melbourne and a colleague noted the authors said many of the triggers for deprescribing can be identified only by a medicine review.

“But does evidence show that these transitions currently lead to a medicine review?,” they asked.

“In Australia….. studies of HMR uptake have found that only 5-10% of older people discharged from hospital, who are referred to an ACAS or community nursing service or who reside in supported accommodation, receive an HMR”.

Many barriers to HMRs have been identified, but most had not been resolved, they said.

“New approaches to improve access to interdisciplinary medicine reviews within primary care are needed to help deprescribing. These include simplification and improved targeting of the HMR model, along with implementation of new collaborative care models integrating pharmacists into general practice clinics, ACAS teams, and community nursing services”.

Leading clinical pharmacist Debbie Rigby agreed with their comments.

“Improved targeting of patients most likely to benefit from HMRs was identified in the HMR qualitative research evaluation in 2008 and in the economic evaluation (VALMER) in 2010, and yet no changes to the program rules have occurred,” she said.

“The only changes to the model have been artificial to constrain the uptake for budgetary reasons. The current caps on HMRs are restricting access to a collaborative, evidence-based, patient-centred service which has been shown to reduce medication misadventure and unplanned hospital readmissions.

GPs and patients value HMRs and the acceptance has grown substantially over the evolution of the service.

The fact that numerous multidisciplinary research projects such as the one published in the BMJ embrace HMRs as part of their research design is a testament to the worldwide respect and value of the program.

New collaborative care models are also needed and should be considered as part of the current reforms and reviews (MBS review, Primary Health Care review, Medical Home model).   

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